Tea and Paracetamol

As the car sped through the narrow streets of San Cristóbal on the way to Hospital Colonial, I huddled feverishly in the backseat, grinding my teeth while the body I thought I owned shook of its own volition, rattling bones like an old black-and-white cartoon featuring dancing skeletons. My mind was becoming increasingly muddled, but when the fuzzy tingle emanating from my hands and feet began to grow and flashes of red light surged in front of my eyes, it still managed to posit the uncomfortable question: was I going to die in Mexico?

I’ve always liked doctors. I grew up in somewhat close contact with them, since my godfather was a doctor and my precocious entry into the world of allergies and broken craniums usually landed me in a grim waiting room surrounded by old ladies trying to look their worst.

Unlike most children I knew, I did not make a run for the hills at the mere sight of a needle and actually welcomed the opportunity to chat with grown-ups whose primary job seemed to involve asking a lot of questions. A doctor’s office was not only a place of healing but also the gripping setting of an ongoing investigation, even if, in order to find the culprit, I had to retrace my steps and eventually rat on my own body.

The passing of the seasons did nothing to diminish my cozy familiarity with the medical profession. I remember little of the myriad reasons which put me under a doctor’s inquisitive gaze, but I recall most of their faces, and particularly their dispositions – kind, funny, strict, etc…

In my days as a country dog in Southern Europe, I witnessed a great deal of chaos in waiting rooms. At any given moment of my youth, there seemed to be a lot of people getting constantly sick. If an essential body part was found to be maimed or in need of fixing, a quick dash to the emergency room was the way to go. Nonetheless, the severity of some cases seemed a tad exaggerated, which accounted for the peculiar sight of someone coughing up blood sitting next to someone with a light sneeze.

The public healthcare system was also renowned for its long waiting lists. To be ill meant learning to wait, and hope death would take longer to arrive than a cure, or at least a consultation. For those with heavier pockets, the shinier offices of private practices offered a less demanding schedule, together with a more personalized service.

As I reached adolescence, pharmacies began to sprout everywhere, selling quick and colorful remedies to an increasingly ailing country. Suddenly, everyone seemed to be on some medication or other, from painkillers to antibiotics, or vitamins to antidepressants. A nation was hooked on promises and newfound money, and a bigger television came accompanied with a larger dose of Xanax. It was a depressing sight, but one which would linger in my memory as, years later, I made my life in Amsterdam.

Boats in the Jordaan

Amidst the canals of Northern Europe, I came in contact with a radically different attitude towards medicine and medication. The ravenous need for something faster, brighter and stronger I had known in the old country was now replaced by an apparent suspicion of anything stronger than paracetamol.

Knowing firsthand the toll of legal drug addiction, I was relieved to be amidst pharmacology Luddites. The predominant laissez-faire attitude struck a chord, and I stood out of a doctor’s way for the first 7 of my 9 years in Amsterdam, even enduring the splintering consequences of my yearly cycling tumbles with a stoicism befitting a true convert.

When I eventually needed to see a doctor, I was surprised by the efficiency and practicality of the Dutch healthcare system. Obtaining health insurance is mandatory, and it is recommended to register with a family doctor, or huisarts, as soon as possible, to ensure one is available to receive new patients. Where to register is entirely up to the patient and their convenience, so my doctors were always a short 5-minute bike ride away.

The cherry on top of the cake was the option of having consultation hours without an appointment, which were usually in the early morning. The first time I showed up for one, I had a bit of trouble finding the doctor’s office because I couldn’t see a queue anywhere. Surely I had been fooled and the practice had moved…

When I finally saw the “Huisarts” sign on the window and rang the doorbell, I was shocked to be introduced to an empty waiting room. Was nobody sick in this city?, I thought. Or did they kill anyone at the mere hint of a cough and dumped their bodies into the canals? It was a bizarre experience, used as I was to the endurance tests of the old country, where to get a spot at 8 in the morning meant arriving at 5, and only after consulting the stars and the winds for favorable conditions.

I was immediately sold: whenever in need of a consultation, I waltzed my way into an early morning spot, left for the pharmacy if necessary and would still be on time for work. I never got anything stronger than cough drops or paracetamol, but my illnesses were never serious to begin with, so all was well in the land of cheese and herring.

Nonetheless, the non-interventionist approach to healthcare favored by Dutch doctors was a common complaint amongst expats, who sometimes felt the need for something more drastic than the standard duo of tea and paracetamol. “The drugs don’t work/they just make you worse” seemed to be the motto in Dutch medical circles…

As for the doctors themselves, they were lovely to talk to. Their English was good and they seemed to enjoy a bit of banter with a cheerful foreigner. As symptoms were discussed, personal histories were unveiled, and I was invariably told stories of volunteering in Africa or Latin America, usually leading to a few words in Spanish, to further prove their worldliness. Before sending me on my way with orders of plenty of rest and a prescription for (can you guess?) tea and paracetamol, they would wish me luck and tell another thing about that time in Nicaragua with the starving children and that other time with the resort and the safari in Kenya.

The few times I did a morning ride to the doctor were short and practical affairs, where the stories flew quickly and an assured professionalism paved the way for a speedy return to work. That is, until I one day showed up with something trickier than a nasty cough.

Amsterdam ambulances

The first symptom was tiredness. I cycled as fast as ever, jumped the stairs at work as briskly as before, but something was amiss. The occasional weekend siestas soon became mandatory “power naps”, ultimately developing into an essential part of my life. I tried to excuse myself from any activities which would endanger my newfound routine, since a weekend without a midday slumber would lead to a groggy week of mental tumbles and increased irritability.

My entire being was overcome by a constant malaise, for the first time not solely existential. To borrow an automotive metaphor, I was running on fumes…

Other symptoms gradually began to rear their smothering head: meals were leaving me unsatisfied and bloated, sleep was mostly a shallow relaxation of the eyes, my chest felt weighed down by a pressure more grinding than gravitational.

One day, sitting at my desk in the office, the wooziness I had become accustomed to increased tenfold, followed by sharp pangs to the chest and an inability to properly breathe. Was I having a panic attack?

No, I wasn’t. It took some convincing though, since that seemed to be the doctor’s preferred explanation. Are you stressed?, he asked on the morning following my work incident. Don’t be ridiculous, I answered. My job was anything but stressful – busy, yes, but I had always been able to distinguish between the two. I was running around a lot, there were pressing deadlines to be dealt with, but I wasn’t flying a plane or controlling the red button which would send the world into a nuclear meltdown.

One of the many things travel has helped me attain is a sense of perspective. My life in Amsterdam was sweet: sure, the food was laughable and the weather rubbish, but friends were there, together with cozy bars, great cheese and Mad Men marathons – and lots of cycling! I had a lot of fun at work and enjoyed the company of fantastic colleagues, who without fail managed to make me guffaw at least a couple of times a day. Nothing is perfect, but I was enjoying life, minus feeling like a senior citizen most of the time…

So a panic attack was eventually thrown out of the window. What followed was business as usual: rest, tea, come back if symptoms persist or deteriorate. A week later I was back, having noticed I was feeling a lot better on an empty stomach than fully satiated. Since nutrients are apparently essential to a balanced lifestyle, I thought it was not a positive sign. Also, my chest hurt.

A quick manual check of my upper torso brought no conclusions, at least to me. The doctor assured me everything was fine, and when I asked “Why do I feel like crap then?” he shrugged his shoulders and replied something along the lines of “You’re getting old and that’s what happens”. Okay, fine. If orange is the new black, maybe 30 is the new 70. Feeling slightly embarrassed by his patronizing dismissal, I made my leave and decided to take it like a man, or the shadow of one.

The days went by as I lived in permanent exhaustion, resigned to the premature decay of my body. Some weeks were better than others, so I became used to my condition’s whims, until at some point it became unbearable and I took another chance at the doctor’s office. Alas, history repeated itself.

After 3 different doctors and 2 different genders, I begged for at least a test – any test, if only they deemed it relevant. A blood test ensued, which a week later was discussed and finally found to be in order. That was the end of the line. I couldn’t push it any further without recourse to a self-inflicted wound or the sudden appearance of a tail.

A storm gathers

All of these small anecdotes came rushing back to me as I was being put in a stretcher and my arm was being pierced by a needle inside a Mexican hospital. I was still shaking uncontrollably, and could feel my body temperature skyrocket. The doctor, a young gentleman called Juan Carlos Castellanos, promptly ordered tests of any fluids running through my spastic body. After extending his inquiry to ascertain the genesis of my situation, he guessed at a “massive kidney infection”, prompted by “severe dehydration”.

He was later proven correct by the results of the clinical analysis. Hence, I was made to spend the night at the hospital, my arm connected to an IV drip and my forehead burning like hellfire. Eventually, the serum and intravenous antibiotics began to take effect, and by the following morning I was back to my old dizzy self. On the way home, I couldn’t stop wondering about what had prompted my first foray into the Mexican healthcare system. Severe dehydration, moi?

We are in San Cristóbal de las Casas, a lovely colonial town in the state of Chiapas surrounded by mountains. It’s not a desert, nor have I been running marathons. Maybe I neglected my optimal liquid intake on occasion, but I was hardly roaming the Sahara with an empty water flask.

The following morning, I woke up feeling rotten again, and could feel the convulsions preparing their entrance. A few hours later I was back in the hospital, where Dr. Carlos Cepeda recognized me from his night shift. I explained the situation, and he thought it deserved a more thorough inspection. The kidneys seemed on their way to antibiotic-fueled recovery, but he then asked me about my sleep patterns and if I had a feeling of constant fatigue. I was taken aback. Could the Dutch and Mexican cases be related? Was there a connection between the victims? Was I in the presence of an international conspiracy?

After patiently dwelling on my history of symptoms, he began to suspect an abdominal issue as the catalyst to all my health troubles. He prescribed some medication which should alleviate my ailments, but scheduled an ultrasound for the following morning and ordered a stool sample, to accurately identify my silent nemesis.

The next day, feeling the freezing gel over my abdomen, I tried to make sense of the various organs being displayed in a dark, almost phantasmagorical screen. Dr. Cepeda identified the organs as he scanned them in my belly, and was finally happy to report no kidney or gallbladder stones, nor anything else amiss. What he did detect was vast amounts of air in my intestines. He hinted that he knew the cause, but wanted to wait for the stool analysis.

When the results came in, he took me aside and pointed to a Latin name typed bold in the white paper: Giardia lamblia. That was it, the invisible intestinal parasite responsible for turning me into a walking mess: it had been carelessly sucking my mojo, wrecking havoc in my body and creating a succession of systematic failures which would eventually lead to a life-threatening kidney infection.

As I now begin my slow healing process, which must be accompanied by a strict diet (no green vegetables unless they are cacti, no alcohol, no beans, no chocolate), I cannot help but think of the several wasted opportunities back in Amsterdam. A shrugging of shoulders meant sleepless nights, constant fatigue and an unpredictable stomach, not to mention the nagging uncertainty over my true physical condition.

Dr. Castellanos and Dr. Cepeda were amazing throughout my whole week of clinical madness. What I admired the most about them was not their knowledge or considerate professionalism, but their patience and ability to ask the right questions. A couple of small-town doctors in Mexico were able to unravel a mystery which eluded 3 generations of Amsterdam doctors. What I find upsetting is not the difference in knowledge, because I feel there is none, but the realization that Dr. Castellanos and Dr. Cepeda were ultimately able to discover the origin of my affliction just because they cared.

Hence, in the spirit of famous Dutch directness, I would like to end this rambling post with a short message to the altruistic, globetrotting, multilingual and surprisingly likeable Dutch doctors:

Speaking the language of the country you live in sometimes helps, while discussing you’r health probs with a doctor that YOU think speaks good English. To say that Dutch doctors to selfabsorbed to care is a step to far for me. But well done that man.

Ingolf, you wonderful man! You have a valid point about the language skills (or lack thereof), but I’m still leaning towards a cultural issue. This is our most popular post so far, and a lot of people have come forward sharing similar experiences, so I’m not alone in my thinking. Of course I’m making a generalization, and I’m sure there are talented and caring doctors in the Netherlands – I just wasn’t lucky enough to meet them. Or maybe you’ve been keeping them all for yourself? 😉 Enormous hug from the both of us! We miss you!

It’s a conspiracy we started to make sure all foreigners die a slow and painful death and don’t come back!

But sweriously, I too have a lot of expats i hang out with, and i have to suffer the “anti paracetamol” stories. But, after reading this story…I am seriously doubting some things i took for granted.

May i start by telling you it sounds to me you need to find yourself a better doctor. Mine, for instance, has no issues referring me, ordering tests, or whatever, if i indicate something is really off.

Secondly, perhaps also it would be an idea to send a letter, or whatever you feel might help, to the “vereniging van huisartsen”, explaining this. I mean, i understand fully the difference in health attitude…but this doctor took you so not seriously that you almost had to pay for that carelessness, with your life. A doctor like that, should NOT be allowed to practice medicine and i sincerely hope you take some form of action.

I am happy to hear you did not have to pay the hefty price, and i wish you all the luck in recovering properly.

Hello Yves! There are a lot of doctors in the Netherlands, and obviously I can’t say that they’re all rubbish. As I mention in the post, the irony is that I liked the Dutch approach, since I feel people all over the world are being over-medicated. As for doctors, I actually saw three of them – young and old, men and women -, and all failed to take a proper look at my shit (literally) 🙂 My main point, enhanced by friends’ similar stories, is that it seems patients’ complaints are often not taken seriously, particularly if the symptoms are ambiguous, which leads me to believe it to be a question of mentality – and that takes a long time to change… Thank you for dropping by and good luck!

Oh wow, I was wondering why I haven’t been seeing you at the usual travel chats. So this is the culprit! I’m glad to read that you’re okay now.

I’ve heard stories about how Dutch doctors don’t really like to prescribe meds and they were always positive. Anything that’s extreme is dangerous, I think, and there needs to be a more balanced approach to prescriptions.

Also, I have to say that I enjoyed this post not only because it’s a great story, but also because of your writing style. It’s different and funny and it’s a slower pace than I find in other travel blogs but I love it.

I chuckled at this: “Was nobody sick in this city?, I thought. Or did they kill anyone at the mere hint of a cough and dumped their bodies into the canals?”

Yep, I was pretty quiet last week… Too busy trying to live! As for the prescriptions, I mostly support the Dutch attitude of “less is better”. The issue here was that there seems to be a trend in Dutch medical circles where a patient is first and foremost a hypochondriac. I find it a bit silly and dangerous. Glad you enjoyed the story though. “Slower pace” is a great description of my writing, and probably my life in general 🙂 Thanks a lot for the support, Deia! Good luck!

The very basic idea of the Dutch government is to rob the whole population with a mandatory health insurance, then to use a well organized network of house-doctor (huisarts) to prevent the sick people from coming to the specialists / hospitals.

Those house-doctors are so polite, listening to your stories as if they were your best friend, then assuring that you would be fine by coming home and take tea and paracetamol.

If you cry while insisting, you would be sent off to the next layer, consisting of the specialists who don’t know the cause of most of your problems, thus to minimize the cost should you must receive a treatment that cause the government some money.

The Dutch people know this, so they have to use the strong words, in a strong manner to get through the layer of polite non-specialist. In the same way, those non-specialist are becoming immune to almost all cries, except when they see that the tears come together with a broken leg and a crying volume of 180 decibel.

You are a foreigner, you don’t know how to complain the effective way. God blesses you.

I am experiencing the same thing, now I am collaborating with a specialist at a hospital to investigate what the cause of the my allergy. I’m feeling proud because even that specialist must need my help, while I am paying him. I am also proud because I have won my huisarts this time to be able to be sent to the hospital. I’m feeling just great. God blesses me.

Hi Cuong! If what you say is true, then I would never have been properly treated in the Netherlands, since I like to leave the drama outside the doctor’s office 🙂 Much luck with your allergy and hope you continue to feel great. Thank you for stopping by!

Wow, what a frustrating story, and I agree — fuck them! Doctors should never make you feel like a hyponchondriac. Especially when you’re actually unwell. Good luck wi the recovery. I’m sure it’s a relief to finally know what was causing it.

Hola Victoria! Yep, it was quite the relief, particularly because I nearly believed I was turning into a hypochondriac. Thanks a lot for your words of encouragement, much appreciated. Wishing you guys a splendid New Year! Good luck!